Wednesday, March 24, 2010

Yay! We passed the bill! No question about it, seeing the House pass the health reform bills, and watching the President sign one of them, felt like moments of triumph. Despite our many many reservations, so many of us have worked so hard over the last year to achieve this victory! From my own work with the remarkable network that has sprung up around EQUAL, and my colleagues at KPFA; to the hard work of women's groups, progressive organizations, and public health; to the members of Congress who took on enormous obstacles: we all have a claim to this step forward. Speaker Nancy Pelosi clearly deserved major credit for working the bill through the Democratic caucus.

But there are bitter disappointments. The public option failed though it was and is popular. Reproductive rights and immigrants' rights are under assault. Corporations are gaining legal as well as de facto rights. The rabid right, while possibly diminishing and cornered, is nevertheless frightening. The opposition leadership is fanning the flames of hate, divisiveness and willful ignorance, as they experience defeat for the first time in a decade. Members of Congress are heckling each other, the President and the public. One staff member described the atmosphere as “vicious.”

It’s not all over yet, even on the most pragmatic level. The Senate will debate all week, and Republicans will attempt every possible maneuver to derail the proceedings.

Both the President and Rep. Dennis Kucinich framed the victory as one that could begin to reverse 30 years of regressive Reagan-era policies. While the details of the bill are largely technical, and far from revolutionary, one has only to think back to the tsunami of corporate opposition that buried similar proposals in the Clinton era to appreciate the potential significance of this accomplishment.

The legislation itself offers significant improvements for health coverage for many, while ducking the most far-reaching controls on costs. The immediate benefits this year include a tax credit for small businesses that offer insurance, a ban on pre-existing condition exclusions for children, the elimination of copayments for preventive care, and a $250 rebate to Medicare beneficiaries who fall into the prescription drug plan’s doughnut hole. In 2014, 16 million people will begin coverage through Medicaid (called MediCal in California), and millions more will be able to buy insurance through pools created by new state-based exchanges. The plan will limit insurance plans’ ability to gouge sick enrollees in the small group market.

The public option would be a crucial factor in controlling costs and holding insurance companies accountable. Like Medicare and other public programs, the public option was envisioned as an entity with the clout to demand lower prices from health care providers, and also a real alternative for people seeking an escape from the predatory insurance industry. Its absence leaves a gaping hole in the program’s viability.

There’s no similar dispassionate analysis of the harm inflicted on women and immigrants. At best, the bills strengthen existing prohibitions on spending federal funds on abortion and for the first time intrude on the right and ability to buy abortion coverage with private dollars; and exclude tax-paying immigrants from health benefits others enjoy. These assaults are driven purely by vitriol.

The job for progressives is to rejoice in the prospects that may be opening up, and to stay angry about what we have lost, while taking a cold, hard look at the power dynamics that landed us here. A map of the House vote suggests a huge geographically-based divide in the U.S., with representatives from the more isolated middle of the country accounting for most of the Republicans, and the 34 Democrats who voted no. Can progressives win primaries against ConservaDems in those districts? A number of organizations are chomping at the bit to find out.

We have to come up with strategies to deepen and consolidate the public’s approval of Medicare as a model for a stronger public role in the health care system, and link state based and national campaigns to pursue it.

Challenging sexism, racism and homophobia will be problematic in an era of economic recession. But our communities are organized and articulate. Winning the power to defend and advance our interests is not an option; our opponents have their knives drawn, in some cases literally.

Quoting Rep. Dennis Kucinich:
“We're at a pivotal moment in American history, and in contrast to a crippled presidency, I have to believe that this effort, however imperfect, will now have a broad positive effect on American society, and make possible many things that might not have otherwise been possible. Once this bill is signed into law, more Americans are going to be aware of this as they ask, What's in it for me? And as they become more familiar with the new law, more people will be accepting this bill. The president will have a stronger hand in domestic and international affairs, and that will be good for the country.”

Is this President up for it, and up to it? Are we? The coming months will tell.

Saturday, March 20, 2010

It's not just about the money. It's about fairness, and equality, and how profoundly our political culture is infused with the imperatives to keep us divided on the most fundamental bases. Our economic and legal systems have been engines of great progress, and also of divisions by class, race, gender, and all manner of measures of privilege and powerlessness.

It is not the same thing that anti-reform protestors on Saturday spat at Rep. Emmanuel Cleaver, and hurled a racial epithet at Rep. John Lewis, and an anti-gay slur at Barney Frank; that there is now consideration of an Executive Order strengthening even further the ban on federal funding for abortion - a life-crushing measure for millions of women - to win votes for health reform; and that the health reform package would extend no benefits to the undocumented workers who, parenthetically, pay taxes and have by and large been wrenched from their homelands by our own destruction of their domestic agricultural economies. Each of these injustices has its own history of oppression, and its heroes, heroines and triumphs.

But aren't we ready, really, to turn a tidal wave of shame and intolerance against the hate-mongers who are fanning these divisions? It's time to demand apologies, resignations, reparations, from right wing demagogues whose time-worn tactics threaten us with real harm, physical and otherwise, and attempt to keep us divided and to deflect attention from the bankruptcy of their own ideas.

Passage of the House health reform bill would be a landmark event in the march toward human justice and equality. We will no longer take it for granted that where we work should determine whether we get health care. Corporations will have to rely on their many other resources to discipline the workforce. More of us will enjoy longer and healthier lives, with greater security. The health care system itself will be constrained in its ability to penalize us for being women, for being older, for being sicker.

Let's turn our attention this Sunday not just to the vote on the House floor, but also to the march for immigrants' rights in Washington, D.C. And building on that, let's continue the momentum we began in November, 2008, to envision and implement an agenda that unites and lifts up all of us.

Monday, March 15, 2010

Let’s face it, politicians can be exasperating. Politicians who run for President get a level of exposure that would make most of us run for cover.

But Dennis Kucinich is taking a drubbing for doing what more progressives should be doing: standing up for a public option as part of the health reform bill, and demanding an ERISA amendment.

This is not a simple matter of getting the health reform bill passed. Passing a health reform bill is a bare minimum requirement for the U.S. to make progress towards an acceptable level of social justice and it should be done. Today’s “Hill” reports that the votes in play are - well, most of them. There are presently 114 Democrats declaring hesitation about the bill:

Last November, 219 Democrats voted to pass a health reform bill, 39 voted No. The bill included a public option, and also included odious provisions limiting access to abortions. Now the speaker needs 216 “yes” votes to pass a scaled back version of the bill, with fixes in the form of a budget reconciliation bill. That means she can lose 37 Democrats.

Some history
Congressman Kucinich voted for the House bill when it went through the Education and Labor Committee. That bill included a public option and an amendment he proposed to the Employee Retirement Income Security Act (ERISA), to permit states to implement single payer systems without facing a court challenge by employers.

Employers like ERISA, they like ERISA’s provisions that preempt state legislation on employment-related health care benefits, and they would be just as happy not to see any changes to it. Passing the amendment through the Committee was not an easy task, and it came about because Republican members of Congress joined some progressives to vote yes, doubtless alert to the fact this provision alone could swell Republican political contributions, and possibly sink the bill if it came before the full House. Nevertheless, the majority of the Committee voted to accept the amendment. Under normal circumstances, that would indicate it would show up in the bill that went to the House for a vote.

You didn’t see that amendment in HR 3692. That’s because in the interim the Chamber of Congress wrote to the House leadership and pledged to oppose the entire bill if it included the ERISA amendment. The House leadership crafted a bill they thought would pass, and that did not include any changes to ERISA. This was before the recent Supreme Court decision giving corporations expansive rights to influence politics. Mr. Kucinich voted “No” on the final bill.

Getting to the Public Option

Now Mr. Kucinich says he would like to discuss changing his vote to a Yes. He wants 2 things in the House bill: A public option. And the ERISA amendment.

Turns out the majority of Americans agree with him. The most popular part of the bill is the public option, and with good reason. Skeptical as we are of the government, allergic as we are to wonkitude, we have no doubt whatsoever about what lies in store for us if we have to start forking over our premiums to the private insurance industry without the option to vote with our feet. We’ll agree to pay up to get close to universal coverage. But we want a safe, affordable haven. The public option offers that, or at least the structural hope of something like that. Despite all that, we hear no end of excuses and proclamations from our elected leaders about why we can’t have it. Last week, a local health advocacy group picketed Kucinich in his district for threatening to vote No on a bill without the P.O.

Kucinich isn’t holding out for a boondoggle, or a minority vendetta. He’s staking a claim for a policy most people want. There are 114 votes in play. One of them belongs to a progressive. Let’s see about moving the other 113. Then we can come back and thank Dennis for voting Yes on a bill we actually helped to shape.

Friday, March 12, 2010

It was tempting to think that the Bush presidencies were an error from which we’ve now recovered. It’s increasingly apparent that there are deep structural fissures in our society that, like the earthquakes in Chile, have not played themselves out. Unlike that force of nature, we can do something about it – but it will take some work. Here are three tests that demand our commitment:

1. The public option. Americans want an alternative to the predatory insurance industry. They aren’t ready to mandate turning the whole apparatus of paying for health care over to the government, and we’re not going to talk them into it this year. But they damn well want a safety valve from corporate insurance.

Now, the public option is a new entity. We can predict with certainty that it will have lower administrative expenses and won’t pay profits or million dollar bonuses to executives based on denying needed care. The finer points are less certain.

But critics on the left who have consistently contended that the public option could never work seized with relish a 10-page memo dashed off by the Congressional Budget Office to House Ways and Means Chair Charles Rangel on October 29, 2009, stating that the public plan would likely enroll only about 6 million of 30 million newly covered lives. This estimate itself rested on some questionable assumptions. The House bill (in Sec. 213) tightly constrained the grounds for variation in premiums. In Sec. 322, it also limited the amount the public plan could pay to providers. Nevertheless, CBO said the public plan would have higher premiums than other plans in the new Exchanges:

That estimate of enrollment reflects CBO’s assessment that a public plan paying negotiated rates would attract a broad network of providers but would typically have premiums that are somewhat higher than the average premiums for the private plans in the exchanges.

In addition CBO stated that:

The public plan would have lower administrative costs than… private plans but would
probably engage in less management of utilization by its enrollees and attract a less healthy pool of enrollees. (The effects of that “adverse selection” on the public plan’s premiums would be only partially offset by the “risk adjustment” procedures that would apply to all plans operating in the exchanges.)

These unsubstantiated assumptions were not repeated in CBO’s extensive (167-page) examination in December, 2009, of the factors involved in speculating on the effects of possible reforms.

We need a public option. Progressives should fight as hard as we can for the most robust possible public plan. A new public entity that could enroll up to 31 million is estimable, next to 25 million in the Veterans Affairs system, 45 million in Medicare, 49 million in Medicaid, and millions more in other federal programs. It is just a step, but it is potentially a step forward.

2. Women’s rights. Abortion restrictions were voted down in the Senate, 54 – 45, scant days before Nelson bludgeoned them back in. But the House does not have a reliable pro-choice majority. The state of Utah has criminalized miscarriages if there is a claim that they are related to an attempted abortion.

I repeat: The state of Utah has criminalized miscarriages if there is a claim that they are related to an attempted abortion.

The attack on reproductive rights is not, it turn out, a side show in health reform. It is a major shot across the bow. The assault is serious, it is not going away, and progressives are going to have to fight about it, hard.

3. Single payer. Unlike the abortion issue, health reform is not a step backwards for state single payer efforts. Employers have been using ERISA (the Employee Retirement Income Security Act) for decades to block state reforms that would make them pay up for health insurance. Crusading Dennis Kucinich could still fight to get his ERISA amendment in the final bill, opening an important new avenue for states, and eliminating likely long court battles.

Happily, progressives are figuring out that if we want a progressive Congress, we need to run progressive candidates. Challengers are showing up in Democratic primaries against Bart Stupak and other pretend Dems, and organizations are springing up to support them. It will take more than the election of November, 2008, to recover from decades of neoliberal politics and corrupt economics. Passing health reform is the step we can take in the next few weeks. Fighting to make it work will be one of the projects we dig in for over the next few years.

Saturday, March 6, 2010

Writing from Santa Cruz, CA, a day after the massive one-day statewide strikes and day of action against the draconian budget cuts to public education in California - uniting teachers and school employee associations with parents and students, tartgeting cuts at every level (kindergarten - high school, community college, university) in our massively dysfunctional state. Something we haven't seen in health reform since the community-based struggles of the early 1970s. I found these excerpts from Ted Marmor's article of 2007 interesting:

Universal Health Insurance 2007: Can We Learn From the Past?
By Theodore Marmor

http://www.dissentmagazine.org/article/?article=863

Americans are not well served by their current medical care arrangements. Compared to our major trading partners and competitors, we are less likely to be insured for the cost of care, and the care that we receive is almost certain to be more costly. Although U.S. medicine has produced many “miracles,” we are not the undisputed leader in medical innovation, only in the costliness and ubiquity of high-technology medicine. Most Americans “covered” by some form of health insurance still worry about its continuation should we or a close family member become seriously ill. Some of us are locked into employment we would gladly leave but for the potential catastrophic loss of existing insurance coverage.

While most commentators decry our peculiar ability to combine insecurity with high cost, the substantial reform of American medicine at the national level has been enormously difficult to achieve, and comprehensive reform has been impossible.

There is now once again a remarkable consensus that American medical care, particularly its financing and insurance coverage, needs a major overhaul.

The bad news for reformers then and now is this: for a variety of ideological and institutional reasons, American politics makes it very difficult to coalesce around a solution that reasonably satisfies the requirements for a stable and workable system of financing and delivering modern medical care. Agreement on the seriousness of the nation’s medical ills will not necessarily generate the legislative support required for a substantively adequate and administratively workable program. That is as true in 2007 as it was in 1948, 1971, 1993, and 2000.

Before an administration and a Congress can meet the challenges of workable reform, they have to resolve—or at least cope with—some of the nastiest ideological and budgetary conflicts in American politics. As did their predecessors, they face the seemingly intractable problems of substance, symbol, and support.

The fight over Medicare illustrates the rarely achieved conditions sufficient for successful (if partial) reform. Before 1965, the conservative coalition was formidable. The Democratic landslide of 1964 swept away the key conservative bases of institutional power: dilatory tactics by the Rules Committee, control of other key committees, and a Congress as a whole less liberal than John F. Kennedy or Lyndon B. Johnson. The massive electoral shift of 1964 held a lesson for future reformers: a fully sufficient condition for reform was a two-to-one Democratic majority in the House of Representatives, a margin large enough to contain within it a (smaller) majority on Medicare.

By 1970, the debate had shifted back from Medicare to national health insurance once again. Though it is difficult for many to remember, the striking feature of the 1970–1974 years was the intense competition among proponents of different forms of universal health insurance. There was the catastrophic proposal advocated by Senators Russell Long and Abraham Ribicoff. There was the Kennedy-Corman bill that closely followed Canada’s national program as of 1971. And there was the Nixon administration’s plan for mandated health insurance for employed Americans known then as the Comprehensive Health Insurance Plan, or CHIP.

Reform failed because shifting coalitions defeated every attempt at compromise—cycling negative majorities, we might say in political science jargon. The majority that agreed on the need for reform consisted of factions committed to different proposals. The more modest proposals—such as the Long-Ribicoff catastrophic bill—seemed too limited to those who wanted to translate the negative consensus into universal, broad coverage. The proposal for employer-mandated insurance—similar in financing to what Bill Clinton later proposed—seemed too indirect, incomplete, and incapable of cost control to those favoring more straightforward forms of national health insurance. And even Ted Kennedy, who moved from his more ambitious version of national health insurance to a compromise plan that he and the powerful Wilbur Mills could both accept, was incapable of organizing a coalition of liberal and conservative Democrats.

What worked once may not, in changed circumstances, work again. What failed may succeed. But some constants in American politics are relevant.

Second, the limits of political feasibility are far less distinct than Beltway commentators seem to recognize.

Third, the role of language and emotive symbols in this policy world cannot be overestimated.

But the central lesson of the past—of both defeats and victories like Medicare—is cautionary in a different sense. It is wise to wait if what is acceptable is not workable. It is foolish to hesitate if what is workable can be made acceptable. If the central elements of a workable plan are acceptable, the pace of implementation can be staggered. But, American political history in this area shows that the opportunities for substantial reform are few and far between, precious enough to make squandering close to a sin.